The implant is
placed over the pectoral muscle and under the breast tissue.

PROS:

Somewhat shorter recovery and healing time, as the
pectoral muscles
have not been disturbed. Because of this fact, usually the
pain is much less with over the muscle placement. The
placement is much better for patients with mild preoperative sagging
and who do not plan to have abreast liftdone. If the patient has sufficient tissue
to cover the implant,over the muscle placementcan be
done easily.

Over the
muscle placement also gives the implants a much more natural feeling
when you use your chest muscles, as there is no distortion of the
implant with this placement.

CONS:

The implant is closer to the surface and could be more visible under
the breast tissue, especially if you do not have a lot of breast
tissue to start with.Rippling is
easier to detect in patients with little to no breast tissue. Saline
implants and also implants with a textured surface both contribute
to this side effect. Sub-glandular placementmay have a higher
incidence of capsular constriction. Bottoming outis
also a complication of this placement as well, so it is always best
to keep your breasts supported as much as possible with a good bra.

You might need
more photos of your breast tissue with a mammogram with over the
muscle placement. Best to make sure you go to a technician
that is familiar with working with implants.

If the patient has significant sagging with
excess breast tissue - usually a patient will be advised to have abreastlift, as getting implants without a lift is
nothing more than enlarging what mother-nature has given you. So if you were saggy to begin this procedure, then usually if you
forgo a lift, you end up just a larger version of what you started
out with. But if you start with
marginal sag or ptosis, then getting over the muscle placement will
in fact help lift up the actual breast somewhat.

The implant is
placed below both the pectoral muscle and overlying breast tissue.

Other names for
Sub-Muscular Placement:

Unders

Partial Unders

Partial Sub-Muscular

Two-thirds of
the implant is covered with the pectoral muscles, and the bottom
third of the implant is covered only with breast tissue. Under
the muscle placement involves separating the two muscles -
pectoralis major muscle and the pectoralis minor from the chest wall
– and inserting the implant in between the two muscles.

It is very
important to ask your plastic surgeon if he or she is recommending
partial under the muscle or full/complete under the muscle placement. As these two placements are different from each other.

PROS:

Less risk of implant visibility andcapsular constriction(however recent studies have proven that both placements have the
same risk of this complication more or less). Sub-muscular placement
offers less mammography interference; allowing the technician to see
the breast tissue much easier. More appropriate when the patient
has a small amount breast tissue. Implants are less noticeable
in terms of rippling and also less palpable.

Breast profile
appears more natural with women with little to no breast tissue –
the breast is defined with a more natural slope because of the
coverage of the implant by the pectoral muscles. If a woman
has weight changes, even due to pregnancy, the muscle supports the
implant and therefore the breast and implant are less likely to sag.

CONS:

Two to three more days of recovery and somewhat more discomfort.
May not be recommended for highly muscular or athletic builds
because of the fact of their over developed pectoral muscles.
Implant distorts when making certain movements – such as swimming,
getting out of a pool, opening a jar, etc. The implant tends
to be a bit higher initially on the chest wall with partial unders
or partial sub-muscular placement,
as this is due to the pectoral muscles.

Once the muscles relax
however, the implants do drop into the pockets that were made.
Because of the placement of the implant only being partially under
the muscle, the lower pole is covered with sub-glandular tissue like
having over the muscle placement. This leaves less support for
the lower pole of the implant, making itvulnerable tobottoming out. As with any placement of implants,
rippling is a fact of life we all come to grips with when we get
these devices. The more tissue you have the better it is going
to be with hiding any unforeseen rippling.

Full
sub-muscular placement for breast implants is not as widely used
today as Partial under the muscle, but seems to be getting more
attention lately.

Complete sub-muscular placement can be
achieved bytrans-axillary,
peri-areolar,
and alsoinframammory foldincisions.Trans-axillaryincision is the only incision that offers no
surgical cutting of the actual pectoral or serratus muscle and the
fascia. With the trans-axillary approach the muscles are
lifted so that the implant can be placed, which will mean less pain
and trauma tothe patient.

With the
peri-areolarand theinframammory foldincision – both methods
requires some cutting of the muscle in order to place the implant so
that it is fully sub-muscular. At one time, this placement was
reserved mainly for women facing breast reconstruction from breast
cancer, however some plastic surgeons have seen the benefits of this
placement with their patients who have little to no breast tissue.

PROS:

This method of implant placement usually was reserved at one time
solely for reconstructive patients. But some plastic surgeons
are seeing the benefits of this placement with patients with very
little breast tissue so that the edges of the implant can be fully
camouflaged. Much lower risks of capsular constriction and
also bottoming out with this placement. With the implant
behind the full muscle, the fascia serves as a support to the device
(making like an internal bra). This is what makes bottoming
out less likely to happen. Also, with mammograms, the readings
are probably the easiest with this placement, as the implant pushes
all the dense breast tissue to the top without any device in its
way.

CONS:

The
most notable disadvantage of having implants placed completely under
the muscle is the pain and the recovery. The implants will
tend to be very high on the chest wall and tight right after
surgery.Sub-muscular
placement of a breast implant may also contribute to the lack of
cleavage with breasts that are widely spaced, especially with the
use of textured surface implants.

Implant distortion tends to be more when it comes to this placement, as it
is behind not only the pectoral muscle but also the serratus muscle. Simple movement might make the implants “dance”, such as opening up
a jar or getting out of a swimming pool. Some patients have
reported that it takes awhile to get use to the implants in this
position with swimming, but as everything in breast augmentation,
patience is a virtue and eventually you will not notice every single
movement.

Subfascia
placement is a newer technique that combines many benefits of the two most
common placements, sub-glandular and also sub-muscular. This placement is
intended as a compromise for women who want sub-glandular placement but also
want the benefits of sub-muscular.

The
subfascia placement approach is done with elevating the soft tissue connection
on top of the pectoralis muscle so that the implant sits under the breast and
under the fascia – but over the muscle. The chest muscles are not disturbed
with this procedure and the fibrous fascia tissue is dissected away from the
front wall of the pectoralis muscles and the implant placed beneath this fascia
layer. Subfasia placement takes longer surgically than sub-glandular placement,
however substantially less time than the placement of sub-muscular.

There is
nothing in plastic surgery literature that supports this technique over the
other type of placements. The theory behind sub-fascia placement is that it
provides more soft tissue coverage over the implant without violating the
muscle, and perhaps decreasing the risk of capsular contracture.

Subfascia
placement works very well for small, thin women who have little or no breast
tissue to cover their implants. The fascia layer helps to smooth and contour
the implant shell, blending the implant into the chest wall.